Tag Archives: Addiction

Drug abuse has existed since the dawn of time (or at least since the first person ground a leaf into powder.) Just about any substance can be misused or abused. Many drugs lend themselves to misuse/abuse due to their mood altering effects. However in recent years antibiotics have become misused as well. As a culture we are not entirely comfortable with discussing prescription or over-the-counter (OTC) drug abuse. We know what drug abusers (a.k.a. junkies) look like; we’ve seen them in movies and magazine features. Surely the (pill taking) carpooling mom next door can’t be abusing drugs; look at her! Those honor students doing homework in the media room can’t be abusing A.D.H.D. medication; look at how well they’re doing! What adds a heavy opaque veil to the detection is that these drugs come from doctors. Doctors know a thing or two about the human body and what is good for us, no? In theory, yes.

Detecting drug abuse during a 3-5 minute office visit is not easy. There are those who live with people day in and day out and still have no knowledge of drug misuse/abuse. This is by no means to suggest that doctors shouldn’t prevent and detect misuse/abuse. Quite the contrary. We need to incentivize the doctors to limit prescription writing (kind of the way drug companies give incentives to write the prescriptions.) Primary doctors need to spend time asking pointed and probing questions and not merely relying upon questionnaires to make diagnoses for mood altering drugs. Doctors must know the signs of dependency and always err on the side of lower dosage. Doctors know the signs of mental illness and should be on alert for signs of self-medicating behavior. Doctors should refer patients to a mental health practitioner if there are any doubts about stability. The mental health practitioner and referring doctor must decide in concert what medication (if any) is best for the patient.

Pharmacies are already set up to detect prescription abuse. But there are gaps and it’s not considered abuse to fill legitimate prescriptions. We need to start with source (or ‘dealer’ as he/she is known on the street.) Doctors are not looking to get people ‘hooked’, not consciously anyway. For the most part they want their patients to be healthy and happy. They certainly don’t want to see their patients in pain, physical or psychic. Pain medication is tricky business and that’s why there are specialists and pain clinics. Managing pain and pain amelioration can’t happen in a 3-5 minute general practitioner’s office visit. General practice is not the place for treating a cognitive, behavioral or mood issue either. Psychologists and psychiatrists are trained to diagnose learning disorders, and behavior and mood disorders. Relying on general practitioners to treat all aspects of the human condition is quaint and ridiculously. No one person can possibly be up to date on all the medical developments of the 21st century.

We’ve become rather blasé about medicine; ironically as it’s become space age in its sophistication. But we are wrong to do so. Often times, dangerously wrong. Drugs are drugs; whether they come in a childproof bottle or a tiny ziploc bag. They can be life saving or ending, and should be treated as such.

It’s fascinating to consider how our attitudes change over time. It is almost amusing to flip through a magazine from more than 40 years ago. Advertisements, editorial content and choices speak volumes about our priorities and concerns at the time of publication. Old movies also tell us much (often in the guise of propaganda or by virtue of what’s left out of a story.) While it’s doubtful that any newlywed couple ever slept in separate twin beds it is for certain that Hollywood wanted us thinking so. A study of older cinema is illuminating in what it tells us about what people held dear and what they scorned. Some of these values are practically foreign to many of us. You might need a crib sheet to understand the subtlety of a woman scorned for working outside the home, or the degenerating effects of a broken home. You may very well need to hit the pause button to consider what exactly ‘ruined’ a woman or what a ‘deserter’ was and what it supposedly said about a person.

How intriguing that we once felt so strongly about issues that have lost their power to shock or hurt. It must be a sign of some sort of progress? Our attitudes about marriage, relationships, parenthood, working, religion, and the public versus the private world have changed drastically since married people were shown sleeping in twin beds. If they choose to be relevant, media (in all forms) must somewhat reflect the realities of the time. Slowly but surely families are depicted as the freeform drawing they often are, rather than the coloring within the lines they might have once been. The melding of the public and private means most of us now know far more than we care to about strangers. Diseases and ‘conditions’ that were once private, feared, or barely noted, are discussed in loud outdoor advertising voices. There really are no private parts anymore. Except one: the mind.

Mental illness, despite all of our progress is still quite demonized and stigmatized in our media. Certainly we can all comfortably bandy about pop-psycholoigy terms. We could probably rattle off the names of a handful of medications for depression or anxiety. Thanks to reality television we think we know what obsessive compulsive disorder is. What we know and what we’re comfortable discussing is cocktail party chatter. Any mental illness serious or complex enough to not warrant a television commercial, magazine advert, awareness campaign or walkathon is a no-go zone. Shrouding mental illness in shame in secrecy only fuels our misunderstanding yet we hold onto this attitude.

When the newsreader intones (in sotto voce) “The suspect sought counseling” we get the message: ‘Oh, he/she is crazy.’ (For the record you know what’s actually crazy? Thinking you’re not crazy.) The toxicity of this message; 1) seeking help for mental health is suspect 2) mental illness is synonymous with criminality is the very definition of stigmatization. The only thing all criminals have in common is that they committed a crime. Mental illness takes many forms and very few of them involve any violent behaviors. People with illnesses are much more likely to hurt themselves (passively or actively.)

It’s the ambiguity of mental illness that is at the core of these attitudes. The mind is confusing. It is difficult to talk about personality disorders in 60 seconds. Many mental illness can be quite complicated and often incurable. A true understanding of the subtleties and complexities is probably best left to the professionals. But we don’t need to understand something to accept it. What we need to do is rebrand mental illness. Newsreaders think nothing of loudly broadcasting starlet rehabilitation for drug addiction or eating disorders (psst: nice lady reading the teleprompter – addiction and eating disorders are mental illnesses.) We speak publicly and loudly about post-traumatic stress disorder and post-partum depression (mental illness, mental illness.) If all mental illnesses were called by their proper name(s) perhaps we could shed the shame. Words are powerful (just think of all the ones you no longer feel comfortable using.) Once mental illness is seen as diverse expansive and existing any and everywhere, we can celebrate and support treatment in a meaningful way.

“This guy’s walking down the street when he falls in a hole. The walls are so steep he can’t get out.” A doctor passes by and the guy shouts up, ‘Hey you. Can you help me out?’ The doctor writes a prescription, throws it down in the hole and moves on.” Then a priest comes along and the guy shouts up, ‘Father, I’m down in this hole can you help me out?’ The priest writes out a prayer, throws it down in the hole and moves on” Then a friend walks by, ‘Hey, Joe, it’s me can you help me out?’ And the friend jumps in the hole. Our guy says, ‘Are you stupid? Now we’re both down here.’ The friend says, ‘Yeah, but I’ve been down here before and I know the way out.'”

This story, written by Aaron Sorkin for The West Wing, never fails to bring an enormous lump to my throat. Human beings have a tremendous capacity for kindness and empathy. We are at our best when we jump into the hole knowing the way out.

Chances are that unless you sleep upon 20 mattresses stacked to the ceiling, something unpleasant has happened in your life at some point. Life happens to us, mostly for better, but sometimes for worse. It’s what we do with the worse that makes us better. If we are wise and fortunate we have strong connections to others. These people may have not been in the same hole, but they know how to hold a hand and make a cup of tea. That often can be more than enough.

There are some circumstances however that cry out for a hole guide. Illness, addiction, bereavement, and violence can result in a trauma that benefits from others’ past experiences. Support groups (and some chat rooms) are built on this premise. During the blinding vortex of trauma (that feels anything but temporary) there’s great comfort in hearing; “Me too.” The ideal gathering will include those who have found their way out of the vortex of trauma. They stand at the top of the hole, torch in hand. We may not take the exact steps they did to reach to top. We may have to stop at times, or even slide backwards. But we keep our eyes on their torch and commit to putting one foot in front of the other.

There is power in reaching out; to comfort or in search of comfort. It takes courage to continue to ask for help (after having bits of paper tossed upon your head.) It takes compassion and a touch of bravery to jump down back into the hole after finding one’s way out. It’s us humans at our very best.

“28 days” has become shorthand for a detoxification program. Perhaps you doubt me. Perhaps you grew up only hearing “28 days” intoned by a distracted health & hygiene teacher while she directed her pointer towards an image evoking more cartoon bull’s head than uterus. Trust me, four weeks (categorized in as days) means something else now. Feel free to give it a test run and announce to your co-workers that you’re taking some time off; 28 days to be precise. Then sit back and watch as one by one your office mates slide up to you and give you an awkward pat on the back, or shyly tell you about their own/their spouse/their parent/their child’s struggle. Be prepared for the happy hour invitations to taper off as well.

“28 Days” has become the normative addiction treatment time to such an extent that a movie was given only that title. No subtitle was necessary; the masses knew exactly what was in store for Sandra Bullock. But how in the world did we get to a point of this time period being synonymous with becoming sober?

Have you ever tried to cultivate a new behavior? Perhaps you’ve quit smoking (if not, you really should consider it) or adopted an exercise program. Maybe you’ve tried to modify someone else’s behavior, say, trying to get an infant to sleep through the majority of the night. The first two weeks are hell. Pure unadulterated hell. Every morning brings the realization that; yes, you have to do that THING again. At two weeks a change in diet is still feeling punitive and perhaps constipating. By three or four weeks, the sulking starts to ebb and a begrudging buy-in takes its place. By six weeks most new behaviors have found their firm footing. Yes, you might still find yourself with a cigarette in your hand (perhaps at your high school reunion where you become a 17 year old trapped in a 42 year old’s body.) But, by week six, your body and mind now have a sense memory and you have gotten past some unconscious triggers. You can have a drink without smoking, finish a meal without smoking, etc. It may always take effort to keep from lighting up, but it doesn’t take every cell in your body to resist.

Keeping that analogy in mind; how in the world is four weeks sufficient time to a) rid the body of substance b) discover why you use the substance c) develop coping mechanisms beyond using d) learn to be in the world without substances? I don’t think there is anyone in the medical profession who would recommend such a brief treatment stint. Six weeks might be sufficient time for some people who do not have multiple diagnoses (ex.; addiction + bipolar) or have not been addicted for too long a period.

Abbreviated treatment, whether 28 days inpatient or 6-10 therapy visits, is the brainchild of insurance companies. There is no doubt that there are many many people who can greatly benefit from short-term problem solving based therapy. But viewing all psychological conditions as the same is as nutty as considering every physical condition as equal. A hospital stay for a tonsillectomy is not the same as that for brain surgery.

Addiction treatment is tricky. Addicts are crafty folk. Their relationship to their substance is the most important thing in the world to them. The substance one is addicted to is not the issue. Removing access to alcohol, drugs, starvation, for 28 days is meaningless. Addicts don’t use because of how it makes them feel, they use to stop feeling like they do without it. Helping someone to find comfort in their body, soul and the world without their substance of choice is hard work. There are no shortcuts. Four weeks is a significant time, it is. It’s a long time to miss a traveling spouse. It’s a long time to wait for test results. It’s a long time to wait for an electrician. But I don’t think it’s enough time to change the fundamental wiring of a human being.

Not too long ago, there was some media buzz about the efficacy of addiction therapy. This is not a popular subject. If one works in the rehabilitation (rehab) industry one is understandably resistant to any metric devices that might prove the methodology ambiguous. Addiction is a very resistant phenomenon. There are occasions, when a society of thinking people can agree, that lacking a 100% guarantee, erring on the side of empathy and care is optimal. For some addicts, the simple act of stopping something in motion, is enough to change their lives. Rehabilitation can be that barricade.

Addiction to alcohol, drugs or eating disorders has never seemed quiet or private to me. I recognize someone in the throes of the phenomenon (whether they are using or not.) People with a Faustian relationship with food are very obvious to me, and I completely understand the entertainment value of metaphorically playing with one’s food. Of course, when it spills into passive suicidal tendencies, all bets are off. It is torture to be in the life of an addict. Addicts can be very unpredictable and by definition, not reliable (their primary relationship is to their addiction.) Empathy can wear thin after multiple incidents. It is helpful to remember that people use drugs, food, and alcohol to the point of personal destruction, NOT because the substances or processes are so tempting, but because without them, life would be unbearable. In other words; drugs, eating disorders and alcohol work. They numb and distract from an inner pain that for some people is devastatingly crippling.

Posh rehab centers are part of the American lexicon. Most of us can rattle off one or two without thought (Hazelden,Betty Ford.) Colleges and universities now address eating disorders via education campaigns, marketing (‘all you can eat’ dining have been replaced with ‘all you care to eat’ dining) staff training and additional counseling staff. Certainly excessive/binge drinking (which can be an indication of alcoholism) has been the bane of higher education for some time (drug abuse, because of its inherent illegality poses more of a conundrum.) Employers contracting with treatment providers has become de rigueur. Clearly, there is treatment available for some.

But what of the veterans? Veterans are returning, and mercifully will continue to do so in even greater number now. They will come back to what kind of treatments and where? This week it was reported that 1 in 5 suicides is that of a veteran. Now, I’d be the first to say that NOT screening people for mental illness before enlistment is absurd. But regardless, we have a problem here. I don’t mean to imply that veterans (or anyone) who commits suicide is an addict. Not at all. But there is overlap. Suicide, most often, is not a well thought out end of life plan, but an act of someone who feels they have no options. Addiction is also the result of feeling there are no feasible options. Teaching people to recognize their pain for what it is, and providing them tools to pull themselves out of that pain, is effective. Rehabilitation, at its best, does just that.

So what’s our plan? If rehabilitation is accepted by the wealthy, the educated and corporate America, as viable treatment for addiction, shouldn’t it be available to all?